The elusive goal of ridding the world of polio is closer than ever now that the crippling disease has been halted in India, the largest of the four countries in which the virus continued to exist.
Critical to this impressive achievement was Dr. Hamid Jafari, a medical officer from the Centers for Disease Control and Prevention (CDC). Jafari managed a public health initiative between the government of India and the World Health Organization (WHO), directed a staff of more than 2,300 people and oversaw the delivery of about 1 billion doses of the polio vaccine to 172 million young children each year between 2008 and 2011. Many of these children were from migrant families or were living in hard-to-reach and high-risk areas.
“India was long thought to be the most difficult country to eradicate polio in the world, but Hamid’s technical and leadership expertise was able to prove the skeptics wrong,” said Dr. Bruce Aylward, WHO’s assistant director general. “He worked with the government to ensure it committed the resources, and he provided an innovative strategy, technical expertise and was a natural diplomat.”
Reports ranged from 559 to 874 cases in India annually between 2006 and 2009, comprising 43 percent of the confirmed cases worldwide. That number reached zero in January 2011 and a year later, India completed a designated 12-month period without a single occurrence. The next month, India was removed from the list of polio-endemic countries.
Polio is a contagious viral illness that mainly affects children and can cause paralysis, difficulty breathing and sometimes death. In the late 1940s to the early 1950s, polio crippled about 35,000 people each year in the United States alone. With the widespread use of vaccines developed in the 1950s, the United States became polio free by 1979.
Dr. Rebecca Martin, director of the Global Immunization Division at CDC, said Jafari, who was on loan to WHO, brought energy and fresh thinking to the National Polio Surveillance Project in India during his five year tenure that ended in March 2012.
“Hamid had innovative solutions such as vaccinations at bus stops and on trains, and he found ways to reach the children of migrant workers. He identified where the populations were and made sure they were vaccinated,” she said.
Martin said the multi-faceted approach included targeting high-risk areas for vaccination campaigns, routine immunization, mobile vaccination teams, research that led to development and use of more effective polio vaccines in a setting of poor sanitation and high rates of diarrhea. She said these strategies are now being used in Afghanistan, Nigeria and Pakistan, the three countries where polio still persists.
Jafari said he looked closely at the problem of children missed by vaccination teams and decided the best way to tackle it was by “weaving a tight net that did not allow children to slip through the program.” To reach the critical population of newborn babies, for example, he had workers routinely register the babies house to house to make sure they were vaccinated.
Jafari said there also was a huge problem in the state of Bihar, a very poor region that was “the last refuge of the virus.” He said large areas of the state flooded every summer from snow melting in the Himalayas. Operations had to be adapted to enable supervision and access. Teams used boats and, motorcycles and waded through water to reach children.
Besides clinics, trains and transit points, Jafari said the program involved visits to more than 60 million houses several times a year and some 2.3 million vaccinators. Surveys confirm that 99 percent of children in the hardest to reach and highest-risk areas are now protected from polio.
“Polio has circulated for millennia in India,” said Anne Schuchat, director of the CDC’s Center for Global Health. “Hamid led the program in India that stopped the spread of poliovirus.”
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